Living tissue harvesting apparatus

ABSTRACT

There is disclosed a living tissue harvesting apparatus according to one aspect of the present invention, comprising a sheath which can be inserted in a body through a cut skin portion, an endoscope inserted through the sheath, a cutting device which is disposed at the sheath and which can cut a living tissue, and a holder which is disposed at the sheath to hold a harvesting object tissue in the body and which includes a press discharge portion to press-discharge the harvesting object tissue in a direction detached from the cutting device, wherein the holder includes a hook portion to catch the living tissue in a position disposed opposite to the cutting device, and the cutting device and hook portion can move with respect to each other.

CROSS-REFERENCE TO RELATED APPLICATIONS

This application is a continuation under 37 C.F.R. §1.53(b) of priorapplication Ser. No. 10/329,947, filed Dec. 24, 2002, by HideyukiKASAHARA et al. entitled LIVING TISSUE HARVESTING APPARATUS and is basedupon and claims the benefit of priority from the prior JapaneseApplications No. 2001-401940, filed Dec. 28, 2001, No. 2002-116512,filed Apr. 18, 2002; and No. 2002-161572, filed Jun. 3, 2002, the entirecontents of all of which are incorporated herein by reference.

BACKGROUND OF THE INVENTION

1. Field of the Invention

The present invention relates to a living tissue harvesting apparatuswhich harvests living tissues, for example, subcutaneous blood vesselssuch as a great saphenous vein under observation of an endoscope,particularly to an improvement of a holder assembled in this livingtissue harvesting apparatus.

2. Description of the Related Art

A cannula and surgical method for use in drawing and harvestingsubcutaneous blood vessels such as a great saphenous vein in anendoscopic manner are known, for example, by PCT/US99/31242 and Jpn.Pat. Appln. KOKAI Publication No. 2000-37389.

The cannula is a straight tubular member which has a device insertingpath inside, and includes an operation portion in a proximal end.Through the device inserting path of the cannula, from an operationportion side, a traction portion, rigid endoscope, and incision forcepsare detachably inserted. The traction portion includes a loop portionprojecting from a tip end of the cannula and having an angle withrespect to an axial direction of the cannula in a distal end.

When the cannula is used to harvest the subcutaneous blood vessels suchas the great saphenous vein in the endoscopic manner, the followingsurgical method is used. That is, as shown in FIG. 73, a referencenumeral 100 denotes a leg. To harvest a harvesting object blood vessel(hereinafter referred to as the blood vessel) C such as the greatsaphenous vein which extends over the whole length to an ankle B from anupper part of an inguinal portion A of a femoral region, a cut skinportion E1, E2, or E3 is made by a scalpel, for example, in any oneportion of an upper portion of the inguinal portion A, knee D, and ankleB immediately above the blood vessel C.

Subsequently, the blood vessel C is exposed in a position of each cutskin portion E1, E3, or E3 by a dissector. Furthermore, a tissue rightabove the blood vessel C is exfoliated by the similar dissector withrespect to a distance from each cut skin portion E1, E2, or E3, whichcan be observed with the naked eye.

FIG. 74 is a sectional view taken along line 74-74 of FIG. 73, referencenumeral 101 denotes a scurf skin, 102 denotes a subcutaneous tissue, 103denotes a connective tissue on the blood vessel, and the blood vessel Cexists under the connective tissue on the blood vessel 103. First, acannula including a conical chip on the tip end of the cannula is usedas the dissector to strip the blood vessel C and peripheral tissue andto form a cavity G. Here, the harvesting of the blood vessel C extendingtoward the inguinal portion A through the cut skin portion E2 of theknee D will be described. The harvesting comprises: removing the conicalchip from the cannula tip end; inserting the cannula into the cavity Gfrom the cut skin portion E2; and inserting the cannula toward the cutskin portion E1 of the knee D along the upper portion of the bloodvessel C during observation with the rigid endoscope.

In the process of the inserting of the cannula into the cavity G, anoperation comprises: operating the operation portion in the proximal endof the cannula to move the traction portion forwards/backwards; holdingthe blood vessel C with the loop portion in the distal end to strip thevessel from the subcutaneous tissue 102 and connective tissue on theblood vessel 103; and cutting a plurality of side branches F branchedfrom the middle of the blood vessel C by the incision forceps. Thisoperation is repeated to harvest the blood vessel C between the cut skinportion E2 and inguinal portion A.

Moreover, in the great saphenous vein extraction system, the bloodvessel C has to be prevented from being damaged when the side branches Fare cut from the blood vessel C to be extracted. To safely cut thebranches it is important to operate the blood vessel C by the tractionportion in an arbitrary direction and to hold the vessel at a distancefrom incision forceps. When the blood vessel C is operated and held bythe traction portion in this manner, tension is applied to the sidebranches F to be cut. Therefore, the side branches F can clearly beidentified, and the side branches F can be cut without damaging theblood vessel C.

However, in the related-art manual operation, when the blood vessel C isheld and pressed by the traction portion, a hand side of root portionsof the side branches F is pressed with respect to the view field inaccordance with a shape of the traction portion. Therefore, when theblood vessel C is pushed in a front surface direction of the view fieldin this state, the blood vessel C is bent, and rises on the back side ofthe side branch F. At this time, the incision forceps are projectedforwards to cut the side branches F, and the blood vessel C which hasrisen may be damaged by mistake.

When the traction portion for holding the blood vessel C exists beforethe side branch F in this manner, the portion obstructs the frontobservation view field, and the positional states of the side branches Fand blood vessel C cannot satisfactorily be. confirmed. Therefore, alsoin this case, the blood vessel C may be damaged by mistake.

Since all the side branches F branched from the blood vessel C aresearched under the endoscope and cut one by one in the above-describedgreat saphenous vein extraction system, it takes considerable time toextract the blood vessel C. Moreover, to cut the side branches F, theside branches F cannot be held by the loop portion.

Therefore, there is possibility that the treatment is performed in theunstable state. In this case, the blood vessel C may be damaged.

BRIEF SUMMARY OF THE INVENTION

An object of the present invention is to provide a living tissueharvesting apparatus which can safely hold living tissues such as ablood vessel without obstructing an observation view field and easilycut the living tissues.

The object of the present invention is achieved by the following livingtissue harvesting apparatus. That is, according to one aspect of thepresent invention, there is provided a living tissue harvestingapparatus comprising: a sheath which can be inserted into a body througha cut skin portion; an endoscope inserted through the sheath; a cuttingdevice which is disposed at the sheath and which can cut a livingtissue; and a holder which is disposed at the sheath to hold aharvesting object tissue in the body and which includes a pressdischarge portion to press-discharge the harvesting object tissue in adirection detached from the cutting device, wherein the holder includesa hook portion to catch the living tissue in a position disposedopposite to the cutting device so that the cutting device and hookportion can move with respect to each other.

A living tissue harvesting apparatus according to another aspect of theinvention comprises a tissue-holding space for holding a tissueharvested and tissue-catching means for opening and closing thetissue-holding space, thereby to catch the living tissue.

BRIEF DESCRIPTION OF THE SEVERAL VIEWS OF THE DRAWING

FIG. 1 is an exploded side view of a living tissue harvesting apparatusaccording to a first embodiment of the present invention;

FIG. 2A is a perspective view of a trocar;

FIG. 2B is a longitudinal sectional side view of the trocar;

FIG. 3A is a longitudinal sectional side view of a treatment sheath fromwhich a rigid endoscope is removed;

FIG. 3B is a plan view of a tip end of the treatment sheath of FIG. 3A;

FIG. 4 is a longitudinal sectional plan view of the treatment sheathfrom which the rigid endoscope is removed;

FIG. 5 is a longitudinal sectional side view of the treatment sheaththrough which the rigid endoscope is inserted;

FIG. 6 is a longitudinal sectional plan view of the treatment sheaththrough which the rigid endoscope is inserted;

FIG. 7 is a diagram seen from an arrow 7 direction of FIG. 5;

FIG. 8 is a longitudinal sectional side view of the tip end of adissector;

FIG. 9A is a perspective view of a blood vessel harvesting apparatus;

FIG. 9B is a perspective view of a tip end of the blood vesselharvesting apparatus;

FIG. 9C is a front view of the tip end of the blood vessel harvestingapparatus;

FIG. 10A is a top plan view of a bipolar cutter;

FIG. 10B is a longitudinal sectional side view of the bipolar cutter;

FIG. 10C is a lower surface view of the bipolar cutter;

FIG. 11A is a top plan view of a blood vessel holder;

FIG. 11B is a longitudinal sectional side view of the blood vesselholder;

FIG. 11C is a front view of the blood vessel holder;

FIG. 12A is a top plan view of a wiper;

FIG. 12B is a sectional view taken along a line 12B-12B of FIG. 12A;

FIG. 13 is a perspective view of a wiper operation portion;

FIG. 14 is a diagram of a state in which a cut skin portion is formed ina leg;

FIG. 15 is a sectional view of a state in which the trocar is attachedto the cut skin portion of the leg and the trocar is used as a guide toinsert the dissector into a cavity;

FIG. 16 is a whole constitution diagram of a state in which the trocaris used as the guide to insert the treatment sheath into the cavity;

FIG. 17 is a diagram showing a monitor image;

FIG. 18 is a sectional view of the state in which the treatment sheathis inserted in the cavity;

FIG. 19 is a sectional view of a treatment state in the cavity;

FIG. 20 is a diagram showing the monitor image;

FIGS. 21A to 21C are perspective views showing a function of the bloodvessel holder;

FIG. 22 is a sectional view inside the body in the treatment state;

FIG. 23 is a diagram showing the monitor image;

FIG. 24 is a diagram showing the monitor image;

FIGS. 25A to 25C are plan views showing the function of the bipolarcutter;

FIGS. 26A and 26B are sectional views inside the body showing thefunction of the bipolar cutter;

FIG. 27 is a sectional view inside the body in the treatment state;

FIG. 28 is a diagram showing the monitor image;

FIG. 29 is a perspective view of the tip end of the treatment sheath;

FIG. 30 is a perspective view of the tip end of the treatment sheath;

FIG. 31 is a perspective view of the tip end of the treatment sheath;

FIG. 32 is a plan view of the blood vessel holder according to a firstmodification example of the first embodiment;

FIG. 33 is a plan view of the blood vessel holder according to a secondmodification example of the first embodiment;

FIG. 34 is a plan view of the blood vessel holder according to a thirdmodification example of the first embodiment;

FIG. 35 is a plan view of the blood vessel holder according to a fourthmodification example of the first embodiment;

FIG. 36 is a plan view of the blood vessel holder according to a fifthmodification example of the first embodiment;

FIG. 37 is a plan view of the blood vessel holder according to a sixthmodification example of the first embodiment;

FIG. 38 is a plan view of the blood vessel holder according to a seventhmodification example of the first embodiment;

FIG. 39A is a front view of the blood vessel holder according to aneighth modification example of the first embodiment;

FIG. 39B is a front view of the blood vessel holder according to a ninthmodification example of the first embodiment;

FIG. 40A a plan view of the blood vessel holder according to a tenthmodification example of the first embodiment;

FIG. 40B is a side view of the blood vessel holder of FIG. 40A;

FIG. 40C is a front view of the blood vessel holder of FIG. 40A;

FIG. 41A is a plan view of the blood vessel holder according to aneleventh modification example of the first embodiment;

FIG. 41B is a side view of the blood vessel holder of FIG. 41A;

FIG. 41C is a front view of the blood vessel holder of FIG. 41A;

FIG. 42A is a side sectional view of an embodiment in which the bloodvessel holder also functions as the wiper;

FIG. 42B is a front view of an apparatus of the embodiment of FIG. 42A;

FIG. 42C is a 42C direction arrow view of FIG. 42A;

FIG. 43 is a sectional view showing another constitution for scrapingoff foreign materials sticking to the bipolar cutter;

FIG. 44A is a longitudinal sectional side view of the tip end of thetreatment sheath, showing the constitution for scraping off the foreignmaterials sticking to the holder;

FIG. 44B is a perspective view seen from an arrow 44B direction of FIG.44A;

FIG. 44C is a front view of the treatment sheath of FIG. 44A;

FIG. 45 is a perspective view showing one example of a treatment modeusing the bipolar cutter which includes a V groove in a side portion andthe holder;

FIG. 46A is a longitudinal sectional side view of the treatment sheathfrom which the rigid endoscope is extracted in the living tissueharvesting apparatus according to a second embodiment of the presentinvention;

FIG. 46B is a plan view of the tip end of the treatment sheath of FIG.46A;

FIG. 47 is a longitudinal sectional side view of the treatment sheaththrough which the rigid endoscope is inserted;

FIG. 48A is a perspective view of the blood vessel harvesting apparatus;

FIG. 48B is a perspective view of the tip end of the blood vesselharvesting apparatus;

FIG. 48C is a front view of the tip end of the blood vessel harvestingapparatus;

FIG. 49 is a plan view of the blood vessel holder;

FIG. 50A is a lower surface view of the blood vessel holder of FIG. 49;

FIG. 50B is a front view of the blood vessel holder;

FIG. 50C is a top plan view of the blood vessel holder;

FIG. 50D is a rear view of the blood vessel holder;

FIG. 51 is a view in a direction of arrow 51 of FIG. 46A;

FIG. 52 is a sectional view of a state in which the treatment sheath isinserted in the body;

FIG. 53 is a perspective view showing a state in which a blood vessel isheld by the blood vessel holder;

FIG. 54 is a view showing a monitor image of FIG. 53;

FIG. 55 is a perspective view showing a state in which a space forcapturing the blood vessel is closed;

FIG. 56 is a view showing the monitor image of FIG. 55;

FIG. 57 shows the monitor image in which the blood vessel holder isrotated in one direction and tension is applied to a side branch;

FIG. 58 shows the monitor image in which the side branch is cut by thebipolar cutter in the state of FIG. 57;

FIG. 59 shows the monitor image in which the blood vessel holder isrotated in a direction opposite to that of FIG. 57 and tension isapplied to the side branch;

FIG. 60 is a plan view showing that the side branch is continuouslytreated;

FIG. 61 is a partially sectional plan view showing a first example of anengagement constitution of a holding rod and blood vessel holder mainunit;

FIG. 62 is a partially sectional plan view showing a second example ofthe engagement constitution of the holding rod and blood vessel holdermain unit;

FIG. 63A is a partially sectional plan view (open state) showing a thirdexample of the engagement constitution of the holding rod and bloodvessel holder main unit;

FIG. 63B is a partially sectional plan view (closed state) showing athird example of the engagement constitution of the holding rod andblood vessel holder main unit;

FIG. 64A is a partially sectional plan view (open state) showing afourth example of the engagement constitution of the holding rod andblood vessel holder main unit;

FIG. 64B is a partially sectional plan view (closed state) showing thefourth example of the engagement constitution of the holding rod andblood vessel holder main unit;

FIG. 65 is a plan view of a first modification example of the bloodvessel holder of a second embodiment;

FIG. 66A is a plan view (closed state) of a second modification exampleof the blood vessel holder of the second embodiment;

FIG. 66B is a plan view (open state) of the second modification exampleof the blood vessel holder of the second embodiment;

FIG. 67A is a front view of a third modification example of the bloodvessel holder of the second embodiment;

FIG. 67B is a plan view of the blood vessel holder of FIG. 67A;

FIGS. 68A to 68D are explanatory views of a function of the blood vesselholder of FIGS. 67A and 67B;

FIG. 69A is a front view of the blood vessel holder in the closed stateaccording to a fourth modification example of the second embodiment;

FIG. 69B is a plan view of the blood vessel holder of FIG. 69A;

FIG. 70A is a front view of the blood vessel holder in the open stateaccording to the fourth modification example of the second embodiment;

FIG. 70B is a plan view of the blood vessel holder of FIG. 70A;

FIG. 71 is a perspective view showing an opening/closing mechanism ofthe blood vessel holder according to the fourth modification example ofthe second embodiment;

FIG. 72 is a perspective view of an operation portion cover in which theopening/closing mechanism of FIG. 71 is incorporated;

FIG. 73 is a diagram of a state in which the cut skin portion is formedin the leg; and

FIG. 74 is a sectional view along line 74-74 of FIG. 73.

DETAILED DESCRIPTION OF THE INVENTION

Embodiments of the present invention will be described hereinafter withreference to the drawings.

FIG. 1 shows an endoscopic blood vessel harvesting apparatus as a livingtissue harvesting apparatus in which a holder (blood vessel holder)according to a first embodiment of the present invention isincorporated. This apparatus is constituted of a trocar 1, treatmentsheath 2, dissector 3 as expansion means, and rigid endoscope 4 as anendoscope.

As shown in FIGS. 2A and 2B, the trocar 1 is integrally molded of asynthetic resin material, and a cylindrical guide tube 6 is obliquelyinserted through a substantially disc-shaped flange 5. The inner andouter surfaces of the guide tube 6 are coated with a lubricant in orderto improve slip at an insertion time. A tip end 6 a of the guide tube 6is cut at an acute angle, and the end surface of the tip end 6 a isformed substantially in parallel to the flange 5.

Furthermore, an airtight ring portion 7 is integrally disposed in aninner peripheral surface in a base end of the guide tube 6, and an airsupply head 8 is integrally disposed in a middle portion. Moreover, anadhesive layer 9 such as an adhesive tape is disposed on the lowersurface of the flange 5, and the trocar 1 can be fixed so as to adhereto a scurf skin.

The treatment sheath 2 will next be described. The sheath is constitutedas shown in FIGS. 3A, 3B and 4. A sheath main unit 10 is a straightcylindrical member formed of a synthetic resin material, and the surfaceof the unit is coated with a lubricant to improve slip at an insertiontime. An operation portion cover 11 constituting a grasp portion isattached to a proximal end of the sheath main unit 10, and a tip endcover 12 is attached to a distal end.

As shown in FIGS. 3A and 3B, an endoscope channel 13 is disposed overthe whole length of an axial center portion of the sheath main unit 10.The proximal end of the endoscope channel 13 projects on a hand sidethrough the operation portion cover 11, and a flange portion 13 aprojecting from the front end surface of the sheath main unit 10 isdisposed in a distal end. A first treatment device channel 14 isdisposed in a portion eccentric upwards and a second treatment devicechannel 15 is disposed in a portion eccentric downwards so that theendoscope channel 13 is held between the channels in the sheath mainunit 10. Therefore, the first treatment device channel 14 and secondtreatment device channel 15 are substantially symmetrically arranged inpositions most apart from each other via the endoscope channel 13.

The proximal end of the first treatment device channel 14 opens in afirst slide operation portion 16 inside the operation portion cover 11,and the proximal end of the second treatment device channel 15 opens ina second slide operation portion 17 in the operation portion cover 11. Abipolar cutter 18 as a cutting apparatus described later is insertedthrough the first treatment device channel 14 so that the cutter canmove forwards/backwards in an axial direction, and a treatment deviceoperation portion 19 is disposed in a range of an elongate hole 16 a ofthe first slide operation portion 16 in the proximal end so that theportion can slide in the axial direction. When the treatment deviceoperation portion 19 is pulled to the proximal end, the distal end ofthe bipolar cutter 18 can be held in the first treatment device channel14. Moreover, the bipolar cutter 18 is connected to a bipolar cable 20,and the bipolar cable 20 is derived toward the outside through theelongate hole 16 a.

A blood vessel holder 21 as a blood vessel holding member describedlater is inserted through the second treatment device channel 15 in sucha manner that the holder can move forwards/backwards in the axialdirection, and a holder operation portion 22 is disposed in a range ofan elongate hole 17 a of the second slide operation portion 17 in theproximal end in such a manner that the portion can slide in the axialdirection.

Furthermore, as shown in FIG. 4, a through hole 23 is disposed in theaxial direction in one side portion of the endoscope channel 13 insidethe sheath main unit 10. A wiper rod 25 of a wiper 24 described later isinserted through the through hole 23 in such a manner that the rod canrotate. The distal end of the wiper rod 25 is bent substantially in an Lshape, and a wiper rubber 26 is disposed on the tip end of the rod.

The proximal end of the wiper rod 25 extends to a rotating operationportion 27 inside the operation portion cover 11, and is rotatablysupported on the inner wall of the operation portion cover 11. A wiperoperation portion 28 is fixed to the proximal end of the wiper rod 25,and the wiper operation portion 28 can rotate in a range of an elongatehole 27 a which extends in a peripheral direction of the operationportion cover 11.

Moreover, an endoscope holding portion 30 is disposed on the hand sideof the operation portion cover 11 in a fixed state with respect to theendoscope channel 13. The endoscope holding portion 30 includes asufficient cavity for containing an eyepiece portion 31 of the rigidendoscope 4, and a cutout portion 34 into which a light guide head 33disposed on the eyepiece portion 31 is inserted/engaged is formed in apart (upper part) of a peripheral wall 32.

Therefore, as shown in FIGS. 5 to 7, an insertion portion 35 of therigid endoscope 4 is inserted into the endoscope channel 13, the lightguide head 33 is inserted/engaged into the cutout portion 34 so as tohold the eyepiece portion 31 in the endoscope holding portion 30, therigid endoscope 4 is then held with respect to the treatment sheath 2and positioned in the axial direction. The sheath main unit 10 and theoperation portion cover 11 are secured to the endoscope channel 13 andcan rotate. The endoscope channel 13 and endoscope holding portion 30are fixed. Hence, that part of the treatment sheath 2 which is moredistal from the cover 11 than the rigid endoscope 4 can be held androtate in rotatable state, as long as the treatment sheath 2 and therigid endoscope 4 remain coupled together.

The bipolar cutter 18 will next be described.

As shown in FIGS. 9A to 10C, the bipolar cutter 18 includes: a cuttermain unit 40 which is inserted in a body; a tip-end treatment portion 40a which is disposed in the tip end of the cutter main unit 40 to cut theblood vessel; and electrodes 42, 43 which are disposed in the tip-endtreatment portion 40 a to electrically cut the blood vessel. The cuttermain unit 40 is formed of an insulating member (including a ceramicmember) such as a synthetic resin material, and has a shape of a stripplate member bent in a arc shape along a arc inner peripheral surface ofthe sheath main unit 10. The curved shape (roof shape) of the cuttermain unit 40 prevents the tissue from sagging from the upper side(presses/discharges a fat tissue in a body cavity) as described later,and is useful for securing the view field of the rigid endoscope 4.

A guide portion for guiding the blood vessel into the electrodes 42 and43 with the movement of the cutter main unit 40 in the axial directionis formed in the tip-end treatment portion 40 a of the cutter main unit40. In the present embodiment, the guide portion is formed by a notchgroove (slit) 41 cut in a V shape. In this case, sides 41 a, 41 bforming the V shape extend upwards to the top portion of the arc portionon the proximal-end side from opposite edges of the distal end of thecutter main unit 40, and form a tissue guide surface of the notch groove(hereinafter referred to as the V groove) 41 which tapers on theproximal-end side.

A pair of electrodes 42, 43 disposed opposite to each other arefixed/disposed on a bottom of the V groove 41, that is, an intersectionof the respective sides 41 a, 41 b forming the V shape. The electrodes42, 43 are not disposed in the same plane, and are positioned verticallyopposite to each other.

Of these two electrodes, the upper electrode 42 has a surface arealarger than that of the lower electrode 43. That is, the area of theupper electrode 42 in contact with the tissue is large. On the otherhand, the area of the lower electrode 43 in contact with the tissue issmall. Thereby, a current flows in the lower electrode 43, increasingthe current density in the lower electrode 43. Therefore, the lowerelectrode 43 functions as an incision (cutting) electrode. The currentdensity in the upper electrode 42 does not increase until the cuttingstarts. The upper electrode 42 therefore functions as a coagulationelectrode. Hereinafter, the upper electrode 42 will be referred to as“body-side electrode,” and the lower electrode 43 will be referred to as“cut electrode.”

The body-side electrode 42 and cut electrode 43 are connected to leadwires 44, 45, and these lead wires 44, 45 are laid along the upper andlower surfaces of the cutter main unit 40, and connected to the bipolarcable 20. Furthermore, the lead wires 44, 45 are coated with insulatingfilms 46, 47, and insulated. It is to be noted that portions of thebipolar cutter 18 other than the electrodes 42, 43 may also be formed bya transparent material (acryl, and the like).

The blood vessel holder 21 according to the present embodiment will nextbe described in detail with reference to FIGS. 11A to 11C. As shown inFIGS. 11A to 11C, the blood vessel holder 21 includes one operation rod50 as a shaft portion which is moved forwards/backwards in the sheathmain unit 10, and a main unit which is disposed in the tip end of theoperation rod 50 to hold the harvesting object blood vessel 61. The mainunit is formed of the synthetic resin material substantially in atriangular shape in a plan view, the upper surface is formed in a flatsurface 48, and the lower surface is formed in a arc concave surface 49which forms a press groove to press the harvested blood vessel 61. Thisarc concave surface 49 functions as a press discharge portion whichpresses/discharges the harvested blood vessel 61 in a direction apartfrom the bipolar cutter 18 as described later. Moreover, the operationrod 50 is connected to a lopsided position in a rear-end portion of theblood vessel holder 21 (the operation rod 50 is connected to a positioneccentric from a center axis of the main unit of the blood vessel holder21). It is to be noted that the operation rod 50 is inserted through thesecond treatment device channel 15 so as to be movableforwards/backwards.

The tip end of the blood vessel holder 21 is formed as an acute-angledstripping portion 51 for stripping the tissue. Moreover, first left andright taper surfaces 52 a, 52 b are symmetrically formed in the bloodvessel holder 21 so as to be linked from the stripping portion 51. Thatis, the tip end of the main unit is formed in a taper shape which tapersat the acute angle. Furthermore, inclined surfaces 53 a, 53 b are formedin upper and lower surfaces of the stripping portion 51 toward the tipend so that the upper and lower surfaces have a small width. A hemportion of the first taper surface 52 a on a side opposite to theconnected portion of the blood vessel holder 21 to the operation rod 50is formed on a second taper surface 54 which has a arc shape, and thesecond taper surface 54 is continued to a hook portion 55 including aflat surface which is positioned in the rear end of the blood vesselholder 21 so as to catch the blood vessel. That is, the main unitfurther includes the rear end for catching the living tissue.Concretely, as shown in FIG. 3B, the hook portion 55 is disposed in aposition opposite to the bipolar cutter 18 in the axial direction.

Opposite side walls of the blood vessel holder 21 forming the arcconcave surface 49 include a third taper surface 59 which extendsdownwards from the stripping portion 51, and a fourth taper surface 58which extends downwards from the hook portion 55.

The wiper 24 will be described in detail. The wiper is constituted asshown in FIGS. 12A and 12B. That is, the wiper rubber 26 fixed to thedistal end of the wiper rod 25 is fixed to an L-shaped folded portion ofthe wiper rod 25 by adhesion or insert molding, and is disposed at rightangles to the axial direction. The wiper rubber 26 includes a scrapingportion 26 a which has a triangular section and flexibility. Thereby, byrotation of the wiper rubber 26, foreign particles sticking to theobjective lens surface 4 a of the rigid endoscope 4, such as blood,mucosa, and fat, can be scraped off. In this case, the scraping portion26 a has flexibility. Therefore, even when a stepped portion isgenerated between the tip end surface of the sheath main unit 10 and theobjective lens surface 4 a, the rubber goes beyond the stepped portionand slides against the objective lens surface 4 a.

As shown in FIG. 13, one end of the torsion coil spring 29 including thecoil spring disposed on the wiper rod 25 of the wiper 24 abuts on theend surface of the sheath main unit 10, and the other end is disposedbetween the unit and the wiper operation portion 28 in a compressedstate and is further engaged with the side surface of the wiperoperation portion 28. Therefore, the torsion coil spring 29 generates arotation torque T for rotating the wiper rod 25 in one direction, and aforce F for urging the wiper rod 25 toward the proximal end direction ofthe sheath main unit 10.

Thereby, the wiper rubber 26 is urged in a direction in which the rubberretreats to the side of the objective lens surface 4 a of the rigidendoscope 4, and a direction in which the rubber contacts the objectivelens surface 4 a.

FIGS. 9A and 9B show that the insertion portion 35 of the rigidendoscope 4 is inserted into the endoscope channel 13 of the treatmentsheath 2. In this state, the bipolar cutter 18 and blood vessel holder21 projects from the tip end of the treatment sheath 2. The bipolarcable 20 is connected to a high-frequency generation apparatus 56, and alight guide cable 57 is connected to the light guide head 33.

The dissector 3 will next be described. As shown in FIG. 8, an insertionpath 37 for passing through the insertion portion 35 of the rigidendoscope 4 is disposed in the axial center portion of an insertioncylindrical portion 36 which has a straight cylindrical shape.Hydrophilic coating is provided on the surface of the insertioncylindrical portion 36 in order to improve the slip at the insertiontime. A stripping member 38 formed in a conical shape by a transparentsynthetic resin material is fixed to the distal end of the insertioncylindrical portion 36. An endoscope holding portion 39 is disposed inthe proximal end of the insertion cylindrical portion 36 so that theeyepiece portion 31 of the rigid endoscope 4 is held. It is to be notedthat the endoscope holding portion 39 preferably includes the sameconstitution as that of the endoscope holding portion 30 of thetreatment sheath 2.

A case will be described in which the blood vessel harvesting apparatusconstituted as described above is used to harvest a blood vessel as aharvesting object (hereinafter referred to as the blood vessel) such asa great saphenous vein extending over the whole length including ainguinal portion A of a thigh of a leg and an ankle.

FIG. 14 shows a leg 60 and blood vessel 61. First, when the blood vessel61 between a knee 62 and inguinal portion 63 is harvested, a cut skinportion 64 is made in one portion of the knee 62 right above the bloodvessel 61 by a scalpel.

Subsequently, the blood vessel 61 is exposed in the cut skin portion 64by a forceps. Furthermore, a tissue right above the blood vessel 61 isstripped by a distance which can be observed through the cut skinportion 64 with the naked eyes with a similar forceps.

Subsequently, the rigid endoscope 4 is inserted into the dissector 3.The endoscope 4 is thereby held in the endoscope holding portion 39 andsecured to the light guide head 33. The stripping member 38 is passed isphotographed by a TV camera 75 coupled to a TV camera head 74 that isconnected to the eyepiece portion 31 of the rigid endoscope 4 insertedin the insertion cylindrical portion 36. A monitor 76 displays the imageof the member 38 thus photographed. As shown in FIG. 15, the strippingmember 38 is inserted along the blood vessel 61. Where the member islittle inserted, the guide tube 6 of the trocar 1 is obliquely insertedtoward the inguinal portion 63 (substantially in parallel to the bloodvessel 61, the tip end 6 a is turned downwards, and the adhesive layer 9in the lower surface of the flange 5 is bonded/fixed to a scurf skin 65.In this state, an air supply tube 67 connected to an air supply pump 66is connected to the air supply head 8.

In this case, since the outer peripheral surface of the insertioncylindrical portion 36 is closely attached to the airtight ring portion7, the inside of the guide tube 6 and cavity 69 is brought into anairtight state, and an air supply path 68 is secured between the guidetube 6 and insertion cylindrical portion 36.

The light guide head 33 of the rigid endoscope 4 is connected to a lightsource apparatus 78 via the light guide cable 57. Therefore, the cavity69 can be irradiated and illuminated with an illuminating light from thetip end of the rigid endoscope 4. When the air supply pump 66 is driven,air is supplied into the cavity 69 via the air supply tube 67, airsupply head 8, and air supply path 68, and the cavity 69 is expanded. Atthis time, since the insertion cylindrical portion 36 of the dissector 3adheres to the airtight ring 7, gas does not leak to the outside, andthe cavity 69 can therefore securely be expanded.

A subcutaneous tissue 70 as a lower layer of the scurf skin 65 andconnective tissue on the blood vessel 71 exist in the cavity 69.Moreover, the blood vessel 61 exists in the lower part of the connectivetissue on the blood vessel 71, a plurality of side branches 72 arebranched from the blood vessel 61, and the other ends of the sidebranches 72 are connected to the connective tissue on the blood vessel71. Moreover, a subcutaneous fat 73 is attached to the connective tissueon the blood vessel 71. At this time, when the monitor image is checked,the image is displayed as shown in FIG. 17. The operator can clearlyobserve the blood vessel 61 and side branches 72 by the monitor 76. Itis to be noted that a reference numeral 38 a in FIG. 17 denotes theimage of the tip end of the stripping member 38 of the dissector 3.

In this way, during the inserting of the dissector 3, in a state inwhich the cavity 69 is observed by the monitor 76, the connective tissueon the blood vessel 71, blood vessel 61, and side branches 72 arestripped by the stripping member 38 without damaging the side branches72, and the stripping member 38 is gradually moved forwards by anoperation comprising: little pushing inwards; or little returning themember 38. At this time, even when the dissector 3 isvertically/transversely swung, the trocar 1 is not detached from thescurf skin 65. This is because the trocar 1 is fixed to the scurf skin65 by the adhesive layer 9. In this manner, the dissector 3 is movedfrom the knee 62 toward the inguinal portion 63 along the blood vessel61.

The operation described above is repeated several times on the tissuesurrounding the blood vessel so that the blood vessel may be peeled offat the harvesting region.

When a manual stripping operation is completed by using the dissector 3,the dissector 3 is extracted from the trocar 1. The rigid endoscope 4 isdetached from the dissector 3. As shown in FIG. 16, the endoscope 4 isinserted into the treatment sheath 2. The sheath 2 holding the rigidendoscope 4 is inserted into the guide tube 6 of the trocar 1. Theoperation then goes to a treatment step.

In the treatment step, air is applied from the air supply pump 66. Thedissector 3 holds the tissue scraped. The treatment is performed in theview field of the endoscope, by using treatment sheath 2 inserted.

While the operation portion cover 11 of the treatment sheath 2 isgrasped with operator's one hand, for example, the holder operationportion 22 is moved forwards with the operator's thumb, and the bloodvessel holder 21 then projects from the tip end cover 12 of the sheathmain unit 10. Moreover, the cutter operation portion 19 is movedforwards with the index finger of the hand in which the operationportion cover 11 is held, and the bipolar cutter 18 then projects fromthe tip end cover 12. That is, while the operator holds the operationportion cover 11 with one hand, the operator can move the blood vesselholder 21 or bipolar cutter 18 forwards/backwards.

Therefore, as shown in FIG. 18, when a large amount of subcutaneous fat73 exists in the connective tissue on the blood vessel 71 of the cavity69, the treatment sheath 2 is pushed forwards to expand the cavity 69 ina projected state of the bipolar cutter 18. At this time, the bipolarcutter 18 prevents the tissue from sagging downwards (presses/dischargesthe fat tissue in the body cavity) by the curved shape (roof shape) ofthe cutter main unit 40, so that the view field of the rigid endoscope 4can satisfactorily be secured. Also, at this time, since the lowersurface of the blood vessel holder 21 is formed in the arc concave 49,the holder can be slid and moved forwards on the upper surface of theblood vessel 61, and the blood vessel 61 is not stopped from beingdamaged.

As shown in FIG. 19, the side branches 72 are buried in the subcutaneousfat 73 in some case. In this case, the blood vessel holder 21 isprojected from the treatment sheath 2, and the stripping portion 51 ofthe blood vessel holder 21 is pressed onto the subcutaneous fat 73 tostrip the subcutaneous fat 73 from the blood vessel 61 or the sidebranch 71. When the whole treatment sheath 2 is rotated in theperipheral direction in the guide tube 6 of the trocar 1, the bloodvessel holder 21 can be rotated to exfoliate the subcutaneous fat 73from the side branch 72. Since this state is displayed as the monitorimage in the monitor 76 as shown in FIG. 20, the operator can confirmthe posture of the blood vessel holder 21 by the monitor image, and theblood vessel 61 and side branch 72 are prevented from being damaged.

While the subcutaneous fat 73 of the cavity 69 is removed, the treatmentsheath 2 is pushed into the cavity 69, and the blood vessel holder 21 isallowed to approach the side branch 72 as a target. Also in this case,the arc concave 49 is brought in contact with the upper surface of theblood vessel 61, the holder is slid on the upper surface of the bloodvessel 61 and can be moved forwards, and the blood vessel 61 isprevented from being damaged.

FIGS. 21A to 21C show a manual operation of holding the side branch 72by the blood vessel holder 21. The blood vessel holder 21 has the firsttaper surface 52 a, and this surface is continued to the second tapersurface 54, the blood vessel holder 21 is moved forwards, and the sidebranch 72 first is brought in contact with the first taper surface 52 a(see FIG. 21B).

When the blood vessel holder 21 is further moved forwards, the sidebranch 72 contacts the second taper surface 52 b from the first tapersurface 52 a falls, sliding on the hook portion 55, and caught by thehook portion 55 (see FIG. 21C). That is, the first taper surface 52 a(or the second taper surface 52 b) can allow the blood vessel holder 21to contact the side branch 72, escape from the side branch 72, andeasily move ahead of the side branch 72 (side opposite to the view fieldwith respect to the side branch 72). Moreover, the third taper surface59 also largely contributes to the ease of forward movement of the bloodvessel holder 21. That is, because of the presence of the third tapersurface 59, the blood vessel holder 21 can smoothly move forwardswithout being caught by the tissue which exists below. Therefore, theside branch 72 can easily be held by the forward operation of the bloodvessel holder 21.

When the middle of the side branch 72 is hooked on the hook portion 55of the blood vessel holder 21 and the blood vessel holder 21 is drawn onthe hand side (at this time, for example, the hook portion 55 isrelatively moved with respect to the bipolar cutter 18), tension isapplied to the side branch 72 as shown in FIG. 22. At this time, theblood vessel holder 21 can smoothly move toward the hand side withoutbeing caught by the tissue disposed below because of the presence of thefourth taper surface 58. Since one operation rod 50 is connected to theblood vessel holder 21 at this time, and the observation view field issatisfactory. The operation rod 50 is connected to the positioneccentric from the center axis of the blood vessel holder 21, and theoperation rod 50 lies right above the blood vessel 61. This broadens theobservation view further. Therefore, the running of the blood vessel Ccan easily and clearly be conformed. Hence, the blood vessel holder 21can hold the side branch 72 more readily and firmly. As a result, it iseasy to apply the tension to the side branch 72. Particularly, if theblood vessel holder 21 is formed of the transparent material, thevisibility of the blood vessel and tissue can further be improved(therefore, in another preferred embodiment of the present invention,the blood vessel holder 21 is formed by the transparent material).

FIG. 23 shows the monitor image in which the side branch 72 is hooked onthe hook portion 55 of the blood vessel holder 21. An operator can checkby this monitor image that the side branch 72 has been held. When theside branch 72 is held by the blood vessel holder 21 not on the handside, but on the opposite side of the side branch 72, the side branch 72is positioned on the hand side of the observation view field, and theperiphery of the side branch 72 can clearly be confirmed by the rigidendoscope 4 (when the blood vessel holder 21 is disposed on the handside of the side branch 72, the blood vessel holder 21 obstructs thefront observation view field, and the positional states of the sidebranch 72 and blood vessel 61 cannot satisfactorily be confirmed).Therefore, as described later, the side branch 72 can safely be cutwithout damaging the blood vessel 61.

When the state shown in FIG. 23 is formed, next the bipolar cutter 18 ismoved forwards (the bipolar cutter 18 is relatively moved with respectto the hook portion 55) and approaching the side branch 72 held by theblood vessel holder 21. The hook portion 55 of the holder 21 may not beused, depending upon the position that the side branch assumes. Rather,the side branch may be held at a position away from the hook portion 55.In this case, the blood vessel 61 can be held in the arc concave 49.Further, as seen from the monitor image of FIG. 24, the blood vessel 61can be moved backwards from the bipolar cutter 18 by using the bloodvessel holder 21, preventing the bipolar cutter 18 from contacting theblood vessel 61. This operation can easily be achieved by disposing thebipolar cutter 18 opposite to the blood vessel holder 21 as describedabove. By this arrangement, a predetermined distance can securely bekept between the incised/treated portion of the side branch 72 and theblood vessel 61, the side branch 72 is incised by the bipolar cutter 18in the position apart from the blood vessel 61, and the blood vessel 61can be prevented from being damaged. When the predetermined distance canbe kept between the incised/treated portion of the side branch 72 andthe blood vessel 61 in this manner, a knot margin can be secured inbinding the cut portion of the side branch 72 left on the blood vessel61 side with a ligature or the like, after the side branch 72 is cut andthe blood vessel 61 is extracted. This constitution is therefore useful.

As seen from the monitored image shown in FIG. 24, the hook portion 55of the blood vessel holder 21 may not used, depending upon the positionsthat the blood vessel 61 and the side branch 72 take. Instead, the otherpart of the holder 21, located outside the portion 55, may be used tohold the side branch. In this case, the holder 21 can hold the bloodvessel at its concave surface 49. Thus, the blood vessel 61 can be movedaway from the bipolar cutter 18 by using the blood vessel holder 21, inorder to prevent the cutter 18 from contacting the blood vessel 61.

FIGS. 25A to 25C show a manual operation of cutting the side branch 72by the bipolar cutter 18. Since the V groove 41 is formed in the tip endof the bipolar cutter 18, and when the bipolar cutter 18 is movedtowards the side branch 72, the side branch 72 is drawn toward thebottom of the V groove 41. Therefore, as shown in FIG. 26A, the sidebranch 72 contacts the cut electrode 43, and the body-side electrode 42contacts the connective tissue on the blood vessel 71 or side branch 72.That is, in the bipolar cutter 18 according to the present embodiment,the side branch 72 can be guided into the electrodes 42, 43substantially positioned in the intersection of the respective sides 41a, 41 b by the wall surfaces of the V groove 41 corresponding to therespective sides 41 a, 41 b which form the V shape.

After confirming by the monitor image that the side branch 72 contactsthe cut electrode 43 and the body-side electrode 42 contacts theconnective tissue on the blood vessel 71 or side branch 72, the operatoroperates a foot switch 80 of the high-frequency generation apparatus 56to supply a high-frequency current. The body-side electrode 42 contactsthe blood vessel connecting tissue or the side branch 72 at a largerarea than the cut electrode 43 contacts the tissue or the side branch72. This means that the current density is higher in the cut electrode43 than in the body-side electrode 42. Hence, the cut electrode 43 cancut the tissue efficiently. Then a region in contact with the body-sideelectrode 42 of the connective tissue on the blood vessel 71 or sidebranch 72 is coagulated, and the side branch 72 is cut by the cutelectrode 43. That is, as FIG. 26B shows, the portion of the bloodvessel 61 connected to the connective tissue on the blood vessel 71 bythe side branch 72 is cut off by cutting the side branch 72. At thistime, since the body-side electrode 42 having the large contact area isdisposed on the upper side (body side) farther from the blood vessel 61than the cut electrode 43, the thermal influence on the blood vessel 61is minimized.

Since the bipolar cutter 18 is just pressed onto the blood vessel inthis manner, the blood vessel can be cut by the presence of the V groove41. That is, operation other than the forward/backward movement is notrequired in cutting the blood vessel. Therefore, the degree of freedomof the operation of the whole endoscopic blood vessel harvestingapparatus decreases (necessary operation is performed with a smalldegree of freedom), and operability is enhanced.

When the side branch 72 is cut as described above, as shown in FIG. 27,the blood vessel holder 21 is passed under the blood vessel 61 to liftup the blood vessel. It is confirmed by the monitor image shown in FIG.28 whether or not the side branch 72 is completely cut/treated.

The treatment sheath 2 is further pushed forwards in the cavity 69.While observing the monitored image of the cavity 69, the surgeon maymove the blood vessel holder 21 toward the next side branch 72. Thesurgeon repeats the above-mentioned manual operation, using the bipolarcutter 18, on all side branches 72. The blood vessel 61 is thereby cutcompletely from the connective tissue on the blood vessel 71.

When the method of cutting the side branch 72 is repeated in thismanner, the foreign materials 81 such as blood, mucosa, and subcutaneousfat 73 adhere to the objective lens surface 4 a of the rigid endoscope4, and the view field by the rigid endoscope 4 is sometimes obstructed.In this case, while the operation portion cover 11 remains to begrasped, and when the wiper operation portion 28 is manually rotatedagainst an urging force of the torsion coil spring 29, as shown in FIG.29, the wiper 24 rotates via the wiper rod 25, and the foreign materials81 such as the blood, mucosa, and subcutaneous fat 73 sticking to theobjective lens surface 4 a can be scraped away by the scraping portion26 a of the wiper rubber 26.

The wiper 24 is urged by the torsion coil spring 29. When the wiperoperation portion 28 is released from the fingers, the wiper is returnedin a retreat direction from the objective lens surface 4 a. Therefore,when the above-described operation is repeated several times, even theforeign materials 81 such as the subcutaneous fat 73 adhering to and noteasily dropping from the objective lens surface 4 a can cleanly bescraped off. Moreover, when the fingers are released from the wiperoperation portion 28, the wiper 24 returns, moving a away from theobjective lens surface 4 a and is still biased. Hence, the wiper 24would not project, by accident, into the view field. In other words,wiper 24 would not narrow the view field of the rigid endoscope 4.

Moreover, when the cutting of the side branch 72 by the bipolar cutter18 is repeated, as shown in FIG. 30, the foreign materials 81 such asthe mucosa and subcutaneous fat 73 also adhere to the inner surface ofthe bipolar cutter 18 because of the roof shape of the bipolar cutter18. However, when the bipolar cutter 18 is moved backwards by the cutteroperation portion 19 and drawn into the first treatment device channel14, the mucosa and subcutaneous fat 73 are scraped off by the front endsurface of the sheath main unit 10. Therefore, the foreign materials 81adhering to the bipolar cutter 18 can easily be scraped off. It is to benoted that in the present embodiment, in order to scrape off the mucosaand subcutaneous fat 73 adhering to the bipolar cutter 18 by the frontend surface of the sheath main unit 10, a clearance between the bipolarcutter 18 and sheath main unit 10 (clearance between the outer surfaceof the bipolar cutter 18 and the inner surface of the first treatmentdevice channel 14) is set to be small.

As shown in FIG. 31, the scraped foreign materials 81 stick to theobjective lens surface 4 a of the rigid endoscope 4 and sometimesobstruct the view field. Even in this case, when the wiper operationportion 28 is operated to rotate the wiper 24 as described above, theforeign materials 81 sticking to the objective lens surface 4 a can bescraped off.

While the operation of scraping off the foreign materials 81 sticking tothe bipolar cutter 18 or objective lens surface 4 a is repeated, themanual operation of cutting the side branch 72 to cut the blood vessel61 from the connective tissue on the blood vessel 71 is repeated. Whenthe operation reaches the inguinal portion 63, the cutting of the sidebranch 72 is terminated. Subsequently, the small incision is formed inthe inguinal portion 63 right above the blood vessel 61 with thescalpel. The blood vessel 61 is pulled out through the cut skin portionand cut. The operator can cut the drawn portion of the blood vessel 61,and ligate both cut ends of the blood vessel 61 with a suture.

Subsequently, the harvesting operation of the blood vessel 61 extendingtoward the ankle from the cut skin portion 64 of the knee 62 is carriedout and finally one blood vessel (about 60 cm) is harvested from the cutskin portion 64. The manual operation is basically similar to the manualoperation performed on the blood vessel 61 extending to the inguinalportion 63 from the knee 62, and the description thereof is omitted. Thevessel which is cut on its both sides is removed from the cut skinportion 64.

In the method of harvesting the blood vessel 61, a manual operation isperformed on the inguinal portion 63, and another manual operation isperformed at the ancle. Instead, the blood vessel 61 may be firstscraped from the connecting tissue 71 at both the inguinal portion 63and the ancle. Then, the treatment sheath 2 may be used in place of thedissector 3 when the blood vessel 61 is completely cut from theconnecting tissue 71. This reduces the number of times the sheath 2 andthe dissector 3 should be exchanged with each other. The manualoperation can be more smoothly carried out than otherwise.

As described above, in the blood vessel harvesting apparatus of thepresent embodiment, the blood vessel holder 21 includes the hook portion55 for catching the blood vessel in the position opposite to the bipolarcutter 18, and the bipolar cutter 18 and hook portion 55 can move withrespect to each other. Therefore, when the side branch 72 is hooked onthe hook portion 55 and the blood vessel holder 21 is pulled on the handside, as shown in FIG. 22, the tension can be added to the side branch72. Moreover, the blood vessel 61 can be retracted in a direction apartfrom the bipolar cutter 18 by the blood vessel holder 21 so as toprevent the bipolar cutter 18 from contacting the blood vessel 61. Thatis, the predetermined distance can securely be kept between theincised/treated portion of the side branch 72 and the blood vessel 61,and the side branch 72 can be incised by the bipolar cutter 18 in theposition distant from the blood vessel 61 to prevent the blood vessel 61from being damaged. If the predetermined distance is thus kept betweenthe incised/treated portion of the side branch 72 and the blood vessel61 the knot margin can be secured in binding the cut portion of the sidebranch 72 remaining on the blood vessel 61 side with the ligature, inthe case where the blood vessel 61 harvested is used as a bypass vesselto the heart. This constitution is therefore useful.

Only one operation rod 50 as the shaft portion for supporting and movingforwards/backwards the main unit is attached to the main unit of theblood vessel holder 21 of the present embodiment. Therefore, theobservation view field by the rigid endoscope 4 is not largelyobstructed by the operation rod 50.

Furthermore, in the blood vessel holder 21 of the present embodiment,since the operation rod 50 is connected to the position eccentric fromthe center axis of the main unit, the observation view field furtherbecomes satisfactory, and the holding property of the side branch 72 bythe blood vessel holder 21 is also improved. As a result, the tension iseasily applied to the side branch 72. Moreover, when the operation rod50 is disposed in the position eccentric from the center axis of theblood vessel holder 21 in this manner, the operation rod 50 is notpositioned on the blood vessel 61, and therefore the running of theblood vessel C can easily and clearly be confirmed.

Additionally, since the blood vessel holder 21 of the present embodimenthas the tip end (stripping portion 51 and taper surfaces 52 a, 52 b)formed in the taper shape tapering at the acute angle, the holdercontacts the side branch 72, escapes from the side branch 72, and caneasily move ahead of the side branch 72 (on the opposite side of theview field with respect to the side branch 72). Therefore, the sidebranch 72 can easily be held by the blood vessel holder 21 not on thehand side of the side branch 72, but on the opposite side. As a result,the side branch 72 is position on the hand side of the observation viewfield, the periphery of the side branch 72 can clearly be confirmed bythe rigid endoscope 4, and the side branch 72 can safely be cut withoutdamaging the blood vessel 61.

A modification example of the blood vessel holder 21 will next bedescribed with reference to FIGS. 32 to 41B. It is to be noted that theconstituting portions common to those of the above-described embodimentare denoted with the same reference numerals and the description thereofis omitted in the following modification example.

For a blood vessel holder 21A according to a first modification exampleshown in FIG. 32, a hook portion 55A in the rear end substantially has aC shape. That is, the rear end of the main unit of the blood vesselholder 21A has a holding surface substantially having the C shape tohold the hooked living tissue (it is to be noted that the pressdischarge portion is also disposed). Therefore, according to this mainunit shape, a holding force in holding the living tissue such as theside branch 72 can be improved.

Moreover, a blood vessel holder 21B according to a second modificationexample shown in FIG. 33 includes a groove 100 substantially having a Vshape in the tip end of the holder. Therefore, two stripping portions51A, 51B are formed in the front end, and first taper surfaces 52 a, 52b are formed on opposite sides of the respective stripping portions 51A,51B. Furthermore, the tissue hook portion 55A substantially having the Cshape is formed in the rear end in the same manner as in FIG. 32 (it isto be noted that the press discharge portion is also disposed).Therefore, according to the main unit shape, the function/effect similarto that of FIG. 32 is obtained, and the function/effect similar to thatof the V groove 41 of the bipolar cutter 18 according to theabove-described embodiment can be obtained. That is, when the bloodvessel holder 21 is just moved forwards, the tissue is easily drawn intothe V groove 100, the tissue is thereby stripped/incised by twostripping portions 51A, 51B, and stripping property (incision property)is improved.

Furthermore, for a blood vessel holder 21C according to a thirdmodification example shown in FIG. 34, the rear end of the main unit isformed in a taper shape tapering at the acute angle. That is, a tissuehook portion 55B extends at a predetermined angle θ with respect to asurface P vertical to the operation rod 50 (it is to be noted that thepress discharge portion is also disposed). Therefore, according to thismain unit shape, the tissue hook portion 55B can easily be hooked on theside branch 72 on the front side of the side branch 72 (the oppositeside of the view field with respect to the side branch 72). That is, theholding force of the side branch 72 is improved.

Moreover, a blood vessel holder 21D according to a fourth modificationexample shown in FIG. 35 includes grooves 102, 102 each substantiallyhaving the C shape on opposite sides (it is to be noted that the pressdischarge portion is also disposed). Therefore, according to this mainunit shape, the side branch 72 can be held in the groove 102. Forexample, as shown in FIG. 45, when the V groove 41 of the bipolar cutter18 is disposed beside the cutter main unit 40, the side branch 72 can becut from the side (during the cutting, the bipolar cutter 18 is rotatedas shown by an arrow in the drawing). Therefore, the groove is useful.In this case, the V groove 41 guide the side branch 72 into theelectrodes 42, 43 with the movement of the cutter main unit 40 in thedirection substantially crossing at right angles to the axial direction,and the groove 102 of the blood vessel holder 21D can press the sidebranch 72 from the side (the tension is applied from the side).

For a blood vessel holder 21E according to a fifth modification exampleshown in FIG. 36, the stripping portion 51 is formed on an axial line ofthe operation rod 50 (it is to be noted that the press discharge portionis also disposed). Therefore, according to the main unit shape, sincethe operation force from the operation rod 50 can directly betransmitted to the stripping portion 51, stripping property is enhanced.

For a blood vessel holder 21F according to a sixth modification exampleshown in FIG. 37, the rear end of the main unit is formed in the tapershape which tapers at the acute angle. That is, the tissue hook portion55B extends at a predetermined angle with the operation rod 50 withrespect to the vertical surface P, and the second taper surface 54 isformed longer than that of the above-described embodiment (it is to benoted that the press discharge portion is also disposed). Therefore,according to this main unit shape, the tissue hook portion 55B caneasily be hooked on the side branch 72 on the front side of the sidebranch 72 (the opposite side of the view field with respect to the sidebranch 72) (the holding force is improved). Moreover, when the bloodvessel holder 21 is returned on the hand side from the state of FIG.21C, the holder can smoothly be drawn back without being caught by thetissue by the function of the taper shape of the rear end.

For a blood vessel holder 21G according to a seventh modificationexample shown in FIG. 38, the operation rod 50 is disposed on the centeraxis of the main unit. Moreover, in this case, the stripping portion 51is positioned on the axial line of the operation rod 50 (it is to benoted that the press discharge portion is also disposed). Therefore,according to this constitution, the main unit can be held with a goodbalance by the operation rod 50, the operation force from the operationrod 50 can directly be transmitted to the stripping portion 51, and thestripping property is enhanced.

FIGS. 39A and 39B are diagrams of the blood vessel holder seen from thedirection corresponding to FIG. 11C. A blood vessel holder 21H accordingto an eighth modification example shown in FIG. 39A has a arc concavesurface 49A which has a curvature smaller than that of the arc concavesurface 49 of the above-described embodiment. Therefore, according tothis main unit shape, the holding force of the blood vessel 61 isenhanced.

Moreover, in a blood vessel holder 21I according to a ninth modificationexample shown in FIG. 39B, the arc concave surfaces are formed inopposite upper and lower surfaces of the main unit. That is, the flatupper surface of the main unit forms the arc shape. Therefore, accordingto the main unit shape, the blood vessel 61 can securely be held by theopposite upper and lower surfaces of the main unit. Particularly whenthe blood vessel holder 21 is passed under the blood vessel 61 to liftup the holder as shown in FIG. 27, and it is checked by the monitorimage shown in FIG. 28 whether or not the side branch 72 is completelycut/treated, the blood vessel 61 can securely be held, and thereforethese surfaces are useful.

For a blood vessel holder 21J according to a tenth modification exampleshown in FIGS. 40A to 40C, the section curved downwards on one sidesubstantially forms a hook or L shape, and the holder includes strippingportions 51, 51C in the tip and lower ends, respectively. Therefore, theportions can also bite and strip the tissue positioned under the bloodvessel holder.

A blood vessel holder 21K according to an eleventh modification exampleshown in FIGS. 41A to 41C have a shape vertically inverse to that ofFIGS. 40A to 40C, and the section curved upwards on one sidesubstantially forms the hook or L shape. Therefore, the tissuepositioned above the blood vessel holder can be bitten and stripped, andthe blood vessel 61 can be held from below.

FIGS. 42A to 42C show an embodiment in which the blood vessel holder 21also functions as the wiper 24. As shown, a scraping portion 26 a of awiper rubber 26 is disposed in the rear end surface of the main unit ofthe blood vessel holder 21. Moreover, a side flute 17 b extending in aperipheral direction is formed in and linked with the proximal end ofthe elongate hole 17 a formed in the axial direction of the second slideoperation portion 17, and the holder operation portion 22 can move inthe peripheral direction only in the range of the side flute 17 b.

Therefore, in this constitution, while the holder operation portion 22draws the blood vessel holder 21 on the hand side and the holderoperation portion 22 is positioned in the side flute 17 b, the bloodvessel holder 21 is rotated, and the foreign materials such as themucosa and subcutaneous fat adhering to the objective lens surface 4 aof the rigid endoscope 4 can be scraped off by the scraping portion 26 aof the blood vessel holder 21.

FIG. 43 shows another constitution for scraping off the foreignmaterials 81 sticking to the bipolar cutter 18.

As shown, a cutter containing portion 38 connected to the firsttreatment device channel 14 is disposed in the tip end of the sheathmain unit 10. This cutter containing portion 38 is formed so as tocontain the whole tip-end treatment portion 40 a, when the bipolarcutter 18 is drawn into the sheath main unit 10. A slide frictionportion 90 projecting into the cutter containing portion 38 is formed inthe flange portion 13 a of the endoscope channel 13 which projectsthrough the front end surface of the sheath main unit 10. When thetip-end treatment portion 40 a is drawn into the cutter containingportion 38, the slide friction portion 90 slides onto the bipolar cutter18 (tip-end treatment portion 40 a), and the foreign materials 81adhering to the bipolar cutter 18 (tip-end treatment portion 40 a) canbe scraped off the bipolar cutter 18 (tip-end treatment portion 40 a).More precisely, the slide friction portion 90 is an elastic member orthe like and always closely contacts the bipolar cutter 18. The slidefriction portion 90 need not project so long as it remains in closecontact with the bipolar cutter 18. In other words, the portion 90 canperform its function even if the clearance between it and the cutter 18is small.

With this constitution, the foreign materials 81 can be scraped when thebipolar cutter 18 is drawn into the sheath main unit 10. Moreover, theforeign materials 81 can reliably be scraped from the slide frictionportion 90 which is formed of the elastic member and constantly closelycontacts the bipolar cutter 18 in a satisfactory state. Therefore, theforeign materials 81 from the bipolar cutter 18 can securely be removed.As a result, without obstructing the view field of the rigid endoscope 4during the manual operation, the manual operation can be continuedwithout being discontinued.

FIGS. 44A to 44C show the constitution for scraping off the foreignmaterials sticking to the holder 21 in addition to the constitution ofFIG. 43.

As shown, for one side portion of the sheath main unit 10 of thetreatment sheath 2, in the same manner as in the constitution of FIG. 43(the same clearance constitution as that in the above-describedembodiment may also be used . . . see FIG. 9C), the cutter containingportion 38 for containing the bipolar cutter 18 is disposed, and aholder containing portion 35 for containing the blood vessel holder 21is disposed in the other side portion. A slide friction portion 35 ahaving a small clearance from the blood vessel holder 21 is disposed inthe holder containing portion 35.

In general, the blood vessel holder 21 is pressed onto the blood vessel61, the holder is swung vertically and horizontally, and the bloodvessel holder 21 is used to strip the side branch 72 from thesubcutaneous fat 73. Then, the foreign materials 81 such as blood,mucosa, and subcutaneous fat 73 stick to the blood vessel holder 21, andthe foreign materials 81 sometimes obstruct the view field of the rigidendoscope 4. In this case, in the present constitution, the blood vesselholder 21 is moved backwards by the blood vessel holder 21 so as to drawthe holder into the holder containing portion 35 of the sheath main unit10. Then, because of a slight clearance between the blood vessel holder21 and holder containing portion 35, the blood vessel holder 21 is inthe slide contact with the slide friction portion 35 a, and the foreignmaterials 81 such as the mucosa and subcutaneous fat 73 sticking to theblood vessel holder 21 can be scraped off by the front end surface ofthe sheath main unit 10.

As described above, according to the present constitution, since theforeign materials 81 sticking to the blood vessel holder 21 can easilybe scraped off, and the view field of the rigid endoscope 4 during themanual operation is not obstructed, the manual operation can becontinued without being interrupted.

FIGS. 46A to 60 show a second embodiment of the present invention. It isto be noted that in the present embodiment, the parts common to those ofthe first embodiment are denoted with the same reference numeralshereinafter and the description thereof is omitted.

As shown in FIGS. 46A to 48C, in the present embodiment, a holding rod113 described alter of the blood vessel holder 21 fixed onto the sheathmain unit 10 is inserted through the second treatment device channel 15so that the bar can move forwards/backwards in the axial direction.Moreover, the holder operation portion 22 which can slide in the axialdirection in the range of the elongate hole 17 a of the second slideoperation portion 17 is disposed on the proximal end of the holding rod113.

As shown in FIG. 49, the blood vessel holder 21 includes: one shaftportion 350 fixed to the sheath main unit 10; the main unit 21 a,disposed in the tip end of the shaft portion 350, for holding theharvesting object blood vessel 61; and the holding rod 113 which movesforwards/backwards in the second treatment device channel 15 of thesheath main unit 10 of the treatment sheath 2. In this case, the shaftportion 350 and holding rod 113 form a substantially symmetricpositional relation with respect to the center axis and extendsubstantially in parallel to each other.

As shown in detail in FIGS. 50A to 50D, the main unit 21 a made ofsynthetic resin and shaped like a pentagon as seen from above. A hookportion 370 is provided on the rear side of the main unit 21 a. An uppersurface 348 of the main unit 21 a is formed as a arc concave surfacewhich steadily holds the blood vessel to be harvested 61 from below (onwhich the blood vessel to be harvested 61 is steadily laid). Supportwalls 354 a, 354 b are formed on opposite sides of the upper surface 348to hold the blood vessel to be harvested 61 laid on the upper surface348 from the opposite sides. Among these support walls, one firstsupport wall 354 a is connected to the shaft portion 350. Moreover, theother second support wall 354 b is formed opposite to the holding rod113 which moves forwards/backwards, and includes an engagement hole 355with which the tip end of the holding rod 113 is disengageably engaged.

A hook groove 114 is cut in a connecting portion of the shaft portion350 and first support wall 354 a on a side opposite to the upper surface348 (on the opposite side of the upper surface 348 via the shaft portion350). The hook groove 114 is shaped to hold a blood vessel (the sidebranch 72 described later in the present embodiment). For example, inthe present embodiment, the hook portion is formed in a notch shapeincluding a arc concave surface 114 b which has substantially the samecurvature radius as the outer diameter of the side branch 72 or aslightly larger curvature radius, a rear end surface 114 a of thesupport wall 354 a, and a taper surface 114 c formed in the shaftportion 50.

The tip end of the main unit 21 a is an acute-angle tip portion 351. Themain unit 21 a has first left and right taper surfaces 352 a and 352 b.The surfaces 352 a and 352 b are symmetrical to each other and continueto the tip portion 351. That is, the tip 37 of the main unit 21 a istapered at an acute angle. The lower surface of the tip portion 351includes an inclined surface 353 a. The inclined surface 353 a isinclined, rising toward the tip of the tip portion 351. (The portion 351gradually narrows from the lower end to the upper end.) Note that alower surface 349 of the main unit 21 a is formed as the arc concavesurface along the shape of the upper surface 348. The tip of the mainunit 21 a being so shaped, the treatment sheath 2 can be smoothlyinserted into a body cavity, without contacting the side branch 72 orthe blood vessel 61.

As shown in FIG. 49, the main unit 21 a of the blood vessel holder 21and the shaft portion 350 cooperate with the tip end (tip-end cover 12)of the sheath main unit 10 of the treatment sheath 2 to form a concavespace S for taking in the harvesting object blood vessel 61. This spaceS is opened/closed by the holding rod 113 which moves forwards/backwardsin the second treatment device channel 15 of the sheath main unit 10.That is, the holding rod 113 is positioned in an opened position shownby a broken line, in which the tip end of the rod is sunk in the secondtreatment device channel 15, then the space S is completely opened, andthis allows the blood vessel 61 to be drawn into the space S. On theother hand, the holding rod 113 is positioned in a closed position shownby a one-dot chain line, in which the tip end is engaged with theengagement hole 355 of the second support wall 354 b of the main unit 21a, then the space S is completely closed, and the blood vessel 61 takeninto the space S is held and securely captured. It is to be noted thatthe holding rod 113 is positioned in the closed position and engagedwith the engagement hole 355, and then a stepped portion 115 having thefunction similar to that of the hook groove 114 is provided between thesecond support wall 354 b and holding rod 113.

In the present embodiment, a fixing mechanism is disposed to fix theholding rod 113 in the opened and closed positions. One example of thisfixing mechanism is shown in FIG. 51 (view of FIG. 46A in the directionof the arrow 51). As shown, the fixing mechanism includes a pair of leafsprings 111A, 111B having forceps shapes disposed on opposite ends inthe longitudinal direction of the elongate hole 17 a of the second slideoperation portion 17 in the operation portion cover 11 of the treatmentsheath 2. In this case, the front-side leaf spring 111A defines theclosed position of the holding rod 113, and includes a pair of clawportions 205, 205 projecting on opposite sides in the elongate hole 17a. Moreover, these claw portions 205, 205 form a first engagement space210 which clicks/engages the holder operation portion 22 of the holdingrod 113 between the portions and a front end surface 202 of the elongatehole 17 a. Moreover, similarly, the rear-side leaf spring 11B definesthe opened position of the holding rod 113, and includes a pair of clawportions 206, 206 projecting on the opposite sides in the elongate hole17 a. Moreover, these claw portions 206, 206 form a second engagementspace 212 which clicks/engages the holder operation portion 22 of theholding rod 113 between the portions and a rear end surface 201 of theelongate hole 17 a. That is, in the present embodiment, when the holderoperation portion 22 is positioned (click-engaged) in the firstengagement space 210, the space S for capturing the blood vessel isclosed. When the holder operation portion 22 is positioned(click-engaged) in the second engagement space 212, the space S forcapturing the blood vessel is opened.

In this constitution, the blood vessel harvesting operation is performedby the following method. That is, first the dissector 3 s used tocomplete the stripping operation in the same manner as in the firstembodiment. Subsequently, the treatment sheath 2 is inserted into thebody cavity inflated with the air applied into it. The sheath 2 isinserted until its tip portion 351 reaches the that end of the scrapedblood vessel 61 which lies at the inguinal portion 63. As shown in FIG.53, the blood vessel holder 21 is rotated, together with the treatmentsheath 2, in the end of the stripped blood vessel 61 on an inguinalportion 63 side. The main unit 21 a is slipped under the blood vessel 61so as to scoop up the blood vessel 61 from below by the main unit 21 a.At this time, the holding rod 113 is of course held in an open positionin which the tip end is sunk in the second treatment device channel 15(the holder operation portion 22 is click-engaged in the secondengagement space 212). FIG. 54 shows an observed image by the rigidendoscope 4 at this time, that is, a displayed image by the monitor 76.

As shown in FIG. 52, the blood vessel 61 scooped up by the main unit 21a in this manner is laid on the upper surface 48 of the main unit 21 a,and taken into a concave space S formed by the main unit 21 a and shaft350 of the blood vessel holder 21 and the tip end of the sheath mainunit 10 of the treatment sheath 2. Subsequently, while the blood vessel61 is taken into a space S, the holder operation portion 22 is movedforward, the holding rod 113 is projected from the tip end of the sheathmain unit 10, and the tip end of the holding rod 113 is engaged in anengagement hole 355 of the main unit 21 a (at this time, the holderoperation portion 22 is click-engaged (stopped) in the first engagementspace 210). Thereby, the space S is completely closed, and the bloodvessel 61 taken into the space S is held from opposite sides by theholding rod 113 and shaft 350 and securely captured. This state is shownin FIGS. 55 and 56 (FIG. 56 shows the image displayed in the monitor 76and observed by the rigid endoscope 4). As shown when the space S iscompletely closed, the stepped portion 115 is formed between the secondsupport wall 354 b and holding rod 113. That is, when the space S isclosed by the holding rod 113, two hook grooves 114, 115 are formeddisposed opposite to each other via the center axis of the rigidendoscope 4 on the opposite sides of the blood vessel holder 21.

After the blood vessel 61 is captured in the space S in this manner, thetreatment sheath 2 is returned toward the cut skin portion 64 of theknee 62 on the hand side. At this time, the blood vessel holder 21 whichhas captured the blood vessel 61 is also returned together with thetreatment sheath 2 along the blood vessel 61 under the blood vessel 61.In this case, the blood vessel holder 21, on whose upper surface 348 theblood vessel 61 is laid, can smoothly move forwards/backwards, becausethe upper surface 348 of the main unit 21 a is formed in the arc concavesurface. Moreover, the blood vessel 61 is prevented from being damaged.

When the blood vessel holder 21 is returned toward the hand side asdescribed above, the hook groove 114 of the blood vessel holder 21completely captures the blood vessel 61 from the opposite sides by theshaft 350 and holding rod 113. The holder 21 therefore reliably abuts onall the side branches 72 that extends from the blood vessel 61. That is,the blood vessel holder 21 is returned to the hand side. The side branch72 is therefore be found. Then, the side branch 72 is cut with thebipolar cutter 18. At this time, the following operations are performed.

For example, as shown in FIG. 57, when the hook portion 116 of the bloodvessel holder 21 abuts on the side branch 72 positioned on the side ofthe shaft 350, the blood vessel holder 21 is rotated together with thetreatment sheath 2 (twisted up) in a direction for pulling the sidebranch 72 with respect to the connective tissue on the blood vessel 71(clockwise direction seen on the hand side in FIG. 57), and the tensionis applied to the side branch 72. At this time, since the side branch 72is caught and stably held by the hook groove 114 formed on the shaft 350side, the tension is securely added to the side branch 72 simply bytwisting up the blood vessel holder 21. Moreover, at this time, sincethe blood vessel 61 in the space S is held from the side by the shaft350, the blood vessel does not come off from the space S with thetwisting-up of the blood vessel holder 21. In addition, the side branch72, which is placed in the hook groove 114, can be held firmly. Atension is applied to the side branch 72 as shown in FIG. 57, movingforward the bipolar cutter 18 now opposing the side branch 72. Thebipolar cutter 18 cuts the side branch 72, as is illustrated in FIG. 58.

On the other hand, when the hook portion 370 of the blood vessel holder21 abuts on the side branch 72 positioned on the side of the holding rod113, the blood vessel holder 21 is rotated (twisted up) together withthe treatment sheath 2 in a direction for pulling the side branch 72with respect to the connective tissue on the blood vessel 71(counterclockwise direction as seen on the hand side), and the tensionis applied to the side branch 72. At this time, the side branch 72 iscaught and stably held by the stepped portion 115 formed between theholding rod 113 and second support wall 354 b. Therefore, when the bloodvessel holder 21 is simply twisted up, the tension is securely appliedto the side branch 72. Moreover, at this time, since the blood vessel 61in the space S is supported from the side by the holding rod 113, theblood vessel does not come off from the space S with the twisting-up ofthe blood vessel holder 21. Furthermore, when the tension is applied tothe side branch 72, the bipolar cutter 18 already positioned opposite tothe side branch 72 is moved forwards, and the side branch 72 is cut bythe bipolar cutter 18. This state is shown in FIG. 59.

In the cases shown in FIG. 58 and 59, to move forwards the bipolarcutter 18 to cut the side branch 72, the hook groove 114 and steppedportion 115 of the hook portion 370 hold the side branch 72 from adirection opposite to the advancing direction of the bipolar cutter 18.Therefore, the side branch 72 is pushed forwards by the bipolar cutter18 and does not escape groove 114.

Every time the blood vessel holder 21 abuts on the side branch 72, thatis, every time a side branch 72 is found, the above-described operationis repeated (see FIG. 60). The blood vessel holder 21 is then returnedto the cut skin portion 64. Thus, the side branch 72 on the blood vessel61 can be cut and the blood vessel 61 can completely be separated fromthe living body.

As described above, the living tissue harvesting apparatus of thepresent embodiment includes: the treatment sheath 2 which can beinserted in the cavity through the cut skin portion; the rigid endoscope4 as the endoscope inserted through the sheath 2; the bipolar cutter 18as the cutting device which is disposed integrally with the sheath 2 andwhich can cut the living tissue; and the blood vessel holder 21 which isdisposed integrally in the sheath 2 in order to hold the blood vessel 61as the harvesting object tissue in the cavity. The blood vessel holder21 includes the space S for taking in the blood vessel 61, and theholding rod 113 as a capturing member which openably closes the space Sand captures the blood vessel 61 in the space S. Particularly in thepresent embodiment, the blood vessel holder 21 includes the main unit 21a which has the holding surface (upper surface) 348 which holds theblood vessel 61 before the sheath 2, and the space S is formed betweenthe main unit 21 a and sheath 2.

When the blood vessel 61 is taken into the space S formed by the holder21 and can be captured in this manner, the holder 21 (sheath 2) issimply moved backwards, and the side branch 72 to be cut can be found.That is, instead of finding the side branches 72 one by one and treatingthese branches individually, an operation of moving forwards/backwardsand rotating the holder 21 (sheath 2) in one direction along the bloodvessel 61 is simply repeated, so that all the side branches 72 extendingin various directions from the blood vessel 61 can securely be capturedand can continuously be cut (like an assembly-line operation).Therefore, as compared with the related art, the time of the harvestingtreatment can largely be shortened.

As FIG. 61 shows, the engagement hole 355A has a tapered rim 356A. Thetapered rim 356A allows for displacement of the holding rod 113 withrespect to the engagement hole 355A. FIG. 62 depicts a holding rod 113that has a spherical distal end.

In the present embodiment, the opened and closed positions in theholding rod 113 are fixed by the click mechanism on the hand side, butthe shape of the engagement hole 355 on the main unit 21 a side of theblood vessel holder 21 may also be devised so as to fix at least theclosed position of the holding rod 113. For example, as shown in FIG.61, an engagement hole 355A which has an inner diameter smaller than theouter diameter of the holding rod 113 and in which the tip end of theholding rod 113 is elastically engaged may also be disposed in the mainunit 21 a. Alternatively, as shown in FIG. 62, an engagement hole 355Bwhich has a spherical surface engaged with a spherical portion 113 aformed in the tip end of the holding rod 113 may also be disposed in themain unit 21 a. According to these structures, the holding rod 113 cansecurely be held in the closed position.

FIGS. 63A and 63B show another constitution for fixing the closedposition of the holding rod 113. As shown in FIG. 63A, in thisconstitution, a head portion 113 b and neck portion 113 c are formed inthe tip end of the holding rod 113. On the other hand, an engagementhole 355C disposed in the main unit 21 a includes an engagement portion220 with which the head portion 113 b is engaged, and an annularprotrusion 222 which is engaged with the neck portion 113 c. Therefore,when the tip end of the holding rod 113 is pushed into the engagementhole 355C, as shown in FIG. 63B, the head portion 113 b is engaged withthe engagement portion 220, and the protrusion 222 is engaged with theneck portion 113 c.

FIGS. 64A and 64B show further constitution for fixing the closedposition of the holding rod 113. As shown in FIG. 64A, in thisconstitution, a bent portion 113 d directed into the space S is formedon the tip end of the holding rod 113, and a groove-shaped engagementhole 355D is formed by cutting the outer wall of the second support wall354 b along the shape of the bent portion 113 d in the main unit 21 a.Therefore, when the tip end of the holding rod 113 is pushed into theengagement hole 355D, the bent portion 113 d of the holding rod 113 iselastically deformed outwards from the space S, and engaged with andheld by the engagement hole 355D.

FIG. 65 shows a first modification example of the blood vessel holder 21according to the second embodiment. In this modification example, theshaft portion 350 moves forwards/backwards with respect to the sheathmain unit 10, and the holding rod 113 is fixed to the sheath main unit10. It is to be noted that other constitutions are the same as those ofthe above-described embodiment, and are therefore denoted with the samereference numerals and the description thereof is omitted.

Even with the structure, since the space S can openably be closed, thefunction/effect similar to that of the above-described embodiment can beobtained.

FIGS. 66A and 66B show a second modification example of the blood vesselholder 21. The main unit 21 a of the blood vessel holder 21 according tothis modification example is formed by tip-end holding members 230, 232of a pair of elastic holding rods 116 which move forwards/backwards inthe sheath main unit 10. In this case, the tip-end holding members 230,232 have a symmetric configuration with respect to the center axis ofthe sheath main unit 10. Moreover, the respective holding rods 116 aresymmetrically positioned with respect to the center axis of the sheathmain unit 10. Furthermore, a habit (bending habit) of bending outwardsin a diametric direction of the sheath main unit 10 is imparted to thetip end of each elastic holding rod 116 (see FIG. 66B). When the tipends of the respective elastic holding rods 116 project from the sheathmain unit 10 in FIG. 66B, the space S for capturing the blood vesselformed between the elastic holding rods 116 is opened.

When the respective holding rods 116 are drawn into the sheath main unit10, the respective elastic holding rods 116 can forcedly be returnedinwards linearly in the diametric direction of the sheath main unit 10,and the tip-end holding members 230, 232 of the respective holding rods116 can abut on each other to close the space S for capturing the bloodvessel formed by the respective holding rods 116 (see FIG. 66A).

Since the space S can openably be closed even in this structure, thefunction/effect similar to that of the above-described embodiment can beobtained. Further, the holder 21 can be smoothly pulled from the trocar1 even if the trocar used has a valve (not shown). This helps to enhancethe efficiency of the manual operation.

FIGS. 67A to 68C show a third modification example of the blood vesselholder 21. As shown in FIGS. 67A and 67B, the blood vessel holder 21according to this modification example includes: a pair of shaftportions 350 extending from the sheath main unit 10; support members235, 236 disposed on the tip end of the respective shaft portions 350;and an opening/closing sheet flap 117 extended between the supportmembers 235, 236 to form the main unit 21 a together with the supportmembers 235, 236. In this case, the support members 235, 236 cooperatewith each other to form the concave upper surface 348 of the main unit21 a which holds the blood vessel 61, and the flap 117 is extendedbetween the support members 235, 236 on the side of the upper surface348.

A hook groove 114 is formed between the shaft portion 350 and supportmembers 235, 236 in the same manner as in the above-describedembodiment, and the space S for capturing the blood vessel is formedbetween the shaft portions 350. Moreover, the flap 117 is fixed only toone support member 235 (236). Furthermore, the support members 235, 236has the symmetric configuration with respect to the center axis of thesheath main unit 10. Additionally, the shaft portions 350 aresymmetrically positioned with respect to the center axis of the sheathmain unit 10.

In this constitution, the space S is closed as shown in FIGS. 67A and67B as long as the flap 117 is not forced to be opened. However, whenthe flap 117 is positioned on the blood vessel 61 as shown in FIG. 68A,and the flap 117 is pressed onto the blood vessel 61 as shown in FIG.68B, the flap 117 opens upwards as shown in FIG. 68C, and the bloodvessel 61 can be drawn into the space S as shown in FIG. 68D, and theflap 117 can be closed again.

Therefore, since the space S can openably be closed even by thisconstitution, the function/effect similar to that of the above-describedembodiment can be obtained. Since the symmetric configuration is formed,the blood vessel holder 21 can be smoothly pulled from the trocar 1 evenif the trocar has a valve or the like. This serves to enhance theefficiency of the manual operation.

FIGS. 69A to 72 show a fourth modification example of the blood vesselholder 21. As shown in FIGS. 69A and 69B, the blood vessel holder 21according to the modification example includes: a pair of function rods119 a, 119 b which extend from the sheath main unit 10 and can rotate;and holding members 241, 242 which are disposed in the tip ends of therespective function rods 119 a, 119 b and cooperate with each other toform the main unit 21 a. In this case, the holding members 241, 242 havea symmetric configuration with respect to the center axis of the sheathmain unit 10, and the respective function rods 119 a, 119 b are alsosymmetrically positioned with respect to the center axis of the sheathmain unit 10.

As shown in FIG. 71, the first function rod 119 a is supported by abearing main unit 121 of the operation portion cover 11 so as to berotatable, and fixed to an operation lever 118 rotatably disposed in thebearing main unit 121. Furthermore, a gear 120 is fixed to the firstfunction rod 119 a. Furthermore, the second function rod 119 b isrotatably supported by the bearing main unit 121, and fixed to a gear122.

Additionally, the gears 120, 122 mesh with each other via two gears 121.It is to be noted that FIG. 72 shows an appearance view of the operationportion cover 11 in which the bearing main unit 121 and gears 120, 121,122 are assembled.

Therefore, in this constitution, when the operation lever 118 is rotatedon one side, the first function rod 119 a rotates in the same directionas that of the operation lever 118, the second function rod 119 brotates in a direction opposite to that of the first function rod 119 avia the gears 120, 121, 122, and the space S for capturing the bloodvessel is opened as shown in FIGS. 70A and 70B. On the other hand, whenthe operation lever 118 is rotated on the other side, the function rods119 a, 119 b similarly rotate, and the space S is closed as shown inFIGS. 69A and 69B.

With this constitution it is possible to close the space S can openablybe closed. The function/effect similar to that of the above-describedembodiment can be obtained and the symmetric configuration is formed.Hence, the holder 21 can be smoothly pulled from the trocar 1 even ifthe trocar has a valve or the like. This helps to increase theefficiency of the manual operation.

It is to be noted that, needless to say, the present invention is notlimited to the above-described embodiments, and can variously bemodified/carried out without departing from the scope. For example, inthe above-described embodiments, the present invention is applied to theblood vessel harvesting apparatus, but the present invention can also beapplied to the harvesting of living tissues other than the blood vessel.Moreover, in the above-described embodiment, the bipolar cutter is usedas a high-frequency treatment device which cuts the side branch, but themonopolar cutter may also be used, and an ultrasonic treatment device ora mechanically cutting cutter may also be used.

1. A living tissue harvesting apparatus comprising: a sheath includingdistal and proximal end portions, and a longitudinal axis, the sheathhaving an endoscope channel, a treatment device channel and a cutoutportion for engaging with the endoscope inserted in the endoscopechannel so as to prevent the endocsope from moving in the longitudinaldirection.
 2. The living tissue harvesting apparatus according to claim1, wherein the cutout portion engages with a light guide head of theendoscope.
 3. The living tissue harvesting apparatus according to claim1, wherein the sheath includes an operation portion cover in which thecutout portion is formed, and a sheath main unit including respectivedistal and proximal end portions, and a respective longitudinal axis,the sheath main unit being connected to the operation portion cover soas to be rotatable about the longitudinal axis of the sheath main unit.4. The living tissue harvesting apparatus according to claim 1, whereinthe sheath includes an operation portion cover in which the cutoutportion is formed, and a sheath main unit including respective distaland proximal end portions, and a respective longitudinal axis, thesheath main unit being connected to the operation portion cover so as tobe rotatable about the longitudinal axis of the sheath main unit,against the endoscope engaged with the cutout portion and the operationportion cover.
 5. The living tissue harvesting apparatus according toclaim 1, wherein the cutout portion engages with the endoscope so that aforward end of the endoscope is positioned at a location extended from aforward end of the sheath.
 6. The living tissue harvesting apparatusaccording to claim 1, which further comprises a cutting devicepositioned in the treatment device channel so as to be slidable alongthe longitudinal axis, and in which the cutout portion engages theendoscope to the sheath, so that a forward end portion of the cuttingdevice is positioned in a location outside a view field of the endoscopeinserted in the endoscope channel in a position on a most distal endside.